CLINICAL EVALUATION OF THE MANIFESTATIONS OF INTERSTITIAL LUNG INJURYIN SYSTEMIC SCLERODERMA FROM HIGH-RESOLUTION COMPUTER T OMOGRAPHY DATA

Abstract

Objective: to estimate the detection rate of interstitial lung injury (ILI) and to characterize its manifestations from high-resolution computed tomography (HRCT) data in patients with systemic scleroderma (SSD). Subjects and methods. One hundred and thirty-eight patients with SSD (mean age 47±13 years, median disease duration (from the onset of the first signs but for Raynaud's phenomenon) 6 (range 2.5-11) years; mean systolic pulmonary artery pressure 25 (range 25-32) mm Hg) were examined. Chest HRCT was performed on a Siemens Somatom Emotion 6 apparatus. Results. ILI was found in 82% of the patients with SSD. The detection rate for ILI did not depend on the duration of SSD and was high just in the first years of the disease. The patients with lung injury at the onset of SSD were significantly older than those without lung injury (39 and 31 years, respectively; p < 0.03); and the rate of lung fibrous changes was higher in the older subjects who had the same duration of SSD. Lung parenchymal damage was symmetrical and characterized by the high detection rates of linear and reticular changes (100%), frosted glass symptom (64%), bronchiectases (58%), and signs of honeycomb lung (33%). There was a strictly sequential spread of CT changes from the basal segments of the lower lobes to segment VI and then to the overlying portions. When ILL afflicted the overlying portions, there was an increase in the frequency of the symptoms of irreversible fibrosis. Conclusion. Chest HRCT reveals the characteristic symptoms of ILI and reflects different phases of a fibrosing process in the lung. It is essential to make an in-depth examination using HRCT in all patients with SDD, irrespective of its clinical form in the earliest periods for the timely detection and treatment of ILI.

Keywords

• systemic scleroderma
• interstitial lung injury
• high-resolution computed tomography